Which is a risk of using systemic steroids in SJS/TEN?

• A. Hyperglycemia
• B. Infection
• C. Increased protein catabolism
• D. Decreased wound healing

Answer: (B)

Systemic corticosteroids blunt the immune response and weaken host defenses. In SJS/TEN there is extensive skin and mucosal damage, which already disrupts the barrier that normally keeps bacteria out. Suppressing the immune system with steroids makes it easier for bacteria to invade damaged skin and mucosa, increases the risk of wound infections, and can allow infections to progress to sepsis. Steroids can also mask fever and other signs of infection, delaying recognition and treatment. These factors make infection the most clinically consequential risk in this scenario. While hyperglycemia, protein catabolism, and slower wound healing are real steroid effects, the heightened risk of infection in the context of large-area skin loss is the primary concern.